Does the curvature of your cervical spine play a determinant in the severity of injury sustained in a motor vehicle accident?

Unfortunately, many people can relate to having been involved in a car crash or motor vehicle collision (MVC) at some point in their lives. Whether it was a major accident or a minor one, MVC’s are no fun and can cause a variety of minor to serious injuries to those persons in the vehicles. These injuries are commonly and collectively referred to as ‘Whiplash Injuries’. The financial implications of a MVC, as well as interruption of your daily routine due to whiplash are also other major detriments of car crashes that may take years to recover from.

With more distracted drivers texting and speaking on their phones, MVC’s are on the rise, making for much more dangerous roadways. While we cannot control other people’s behaviors, we can certainly drive more cautiously and defensively to hopefully avoid being in a car accident. Unfortunately, MVC’s do happen despite our best efforts, so being prepared and having a plan in mind is key to recovering quickly and getting back on our feet again.

More serious car accidents mean more serious injuries, ranging from cuts and bruise to broken bones, brain damage, and even death. At first, less serious MVC’s however, may not seem like a big deal, with victims often walking away without a scratch, believing they have escaped the crash unscathed. Others may only complain of a slight headache, neck pain, stiff or kinked neck while resorting to taking over the counter pain killers, or wearing a neck brace to assist with their recovery – something that is far from addressing the true cause of the injury.

What most lay people (and even many physicians) don’t realize is the extent to which the CERVICAL LORDOIS (curvature in your neck from the side) plays a role in both: 1) the extent of the initial injury to the occupant(s) and 2) the long term pain and suffering from whiplash injury to the occupants. Furthermore, the MVC itself will damage the cervical lordosis.

1. Concerning the extent of initial injury, researchers have found that having a well preserved cervical lordosis actually prevents neck tissue damage to the sensitive cervical spine ligaments.1 In the figure at the top, the right hand image demonstrates what a normal cervical curve looks like when viewed from the side and the person facing to the right. In contrast, the same researchers identified that straightened cervical curves and worse yet, reversed (kyphotic) cervical curves predisposed to more severe cervical spine tissue injuries due to more extreme forces acting on the neck during the exact same MVC circumstances. The x-rays above at the far left and the middle show abnormal neck curves where more severe injury to the person is likely to result should they be involved in an MVC.

Thus, if you already have an abnormal cervical curvature prior to any MVC, it is in your best interest to rehabilitate the shape and amount of your cervical lordosis. If you do not, you’re at a higher risk of having more serious injuries should you be involved in a MVC.

2. In terms of long term pain and suffering, several research studies have identified that the patients who experience long term whiplash injuries and suffering are in fact the ones that have abnormal cervical lordosis. Straightened, S-curves, and Reversed cervical curvatures have been found to pre-dispose to the following conditions after MVC.

What many whiplash injured subjects don’t realize is that a slight headache or neck pain is a true sign of a much more serious injury to your cervical lordosis and underlying neck tissues. Spinal misalignments as a result of the sudden jolt of the MVC may manifest immediately, or not become evident at all for a long period of time. But this doesn’t mean the spine is healthy or that no injury was sustained.

The fact is that MVC’s statistically damage the shape of your cervical lordosis. Researchers from Chiropractic BioPhysics have identified that the average patient exposed to a MVC will lose 10 degrees of their cervical lordosis, develop a mid cervical kyphosis, and have increased forward head posture as a result of the MVC.

A misaligned cervical curvature as a result of a MVC is a serious health condition. Altered cervical curves will cause nerve interference – hindrance of critical nerve energy that is responsible for every function of our organs, and every movement of our limbs. Ignoring the cervical spinal misalignment can manifest into pain and discomfort, fatigue, sleep disorders, organ dysfunction, depression, and eventually disease.

If you have been in a minor or major car accident, please see a corrective care chiropractor immediately for a full assessment of the health of your spine, even if you don’t feel any discomfort whatsoever. A small misalignment can only get worse with time, so addressing this injury quickly can mean a faster recovery time and less health problems in the future.

Corrective methods using Chiropractic BioPhysics® or CBP® Technique extension traction procedures and devices are the only true evidence based methods that have been shown to statistically and clinically improve the amount of cervical lordosis without the use of surgery. This has been documented in several clinical trials and case reports.8-11 Other conservative methods may restore the cervical lordosis in selected cases, but these have never been proven in clinical trials and are thus, at best, hit and miss. If you are suffering from an altered cervical lordosis as a result of a MVC, use the procedures that are truly scientifically supported.

Chiropractic Treatments for Whiplash

The appropriate chiropractic treatment is unique to each whiplash injury and is directed at the primary dysfunctions detected during the chiropractic exam.

However, chiropractors commonly employ different chiropractic treatments for whiplash, often including:

Manipulation

Muscle relaxation and/or stimulation

Various exercises

Ergonomic and lifestyle changes.

This article explains when, why and how chiropractors may employ these whiplash treatments for neck pain, shoulder pain, back pain and other related symptoms.Chiropractic Manipulation for Whiplash

The primary whiplash treatment for joint dysfunction, spinal manipulation involves the chiropractor gently moving the involved joint into the direction in which it is restricted.

Also known as a chiropractic adjustment, spinal manipulation may involve the application of a short thrust in that direction. In many cases, instead of a thrust, a slow mobilizing movement is used by the chiropractor.

Muscle Relaxation or Stimulation as Whiplash Treatments

The chiropractor's primary whiplash treatment for related muscle dysfunction, muscle relaxation and/or stimulation consist of gentle stretches to the muscle that has excessive tension or repeated contractions of the muscle that is inhibited.

If the muscle is very tight, a more vigorous stretch may be applied by the chiropractor. Gentle finger pressure techniques may be applied to trigger points to relieve the pain associated with the tight muscles.

McKenzie Exercises and Stabilization/Sensorimotor Activities

Chiropractors may employ different types of exercises, including McKenzie exercisesand/or stabilization and sensorimotor exercises, to help treat patients with whiplash injuries.

McKenzie exercises are specifically designed to reduce disc derangement related to a whiplash injury. They consist of simple movements that are initially done in the office but make for an easy transition to self-care at home. McKenzie exercises also help the patient take an active role in his or her own recovery.

Stabilization and sensorimotor exercise approaches are designed to correct faulty movement patterns in routine activities and everyday life. Such whiplash treatment trains the nervous system to better coordinate and control movement patterns, and improves the ability of the neck muscles to maintain stability of the neck.

These exercises are designed to help in a major trauma, such as a fall or whiplash during a motor vehicle accident, or in "micro trauma" from simple things such as being jostled in a crowd, playing sports or performing occupational or home jobs that require physical effort.

Chiropractic Advice on Ergonomic and Lifestyle Changes

These whiplash treatment suggestions stress improvements for performing everyday activities with minimal strain to the body. The chiropractic advice addresses factors in an individual’s work, home or recreational activities that perpetuate the dysfunctions that result from the whiplash accident.

Additionally, spine care professionals at the chiropractic clinic may teach the patient better "use of self" and, if necessary, stress reduction methods to help chiropractic problems.

Whiplash: More than Standard Neck Pain

“WHIPLASH, A SOFT TISSUE INJURY TO THE NECK, is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion,” according to the National Institutes of Health.1

Approximately two-thirds of people involved in motor vehicle accidents develop symptoms of whiplash. The symptoms usually do not develop until two to 48 hours after the injury. Whiplash can also occur from falls, sports injuries, work injuries and other incidents.

Patients with whiplash injury may complain of pain and stiffness in the neck, extending into the shoulders and arms, upper back and even the upper chest. Two-thirds of patients suffer with headaches, especially at the base of the skull. Patients may also experience dizziness, difficulty swallowing, nausea and even blurred vision after injury, but these symptoms tend to resolve quickly.

According to Marshall, 45 percent to 85 percent of people who suffer a whiplash injury have the symptoms five years after the accident, and 82 percent had a straightening or reversal of their cervical curvature.2 "Many authors regard a straightening or reversal of the normally lordotic curvature to be one of the most significant changes of a whiplash injury.” 3

“The initial injury is due to damage of cervical muscles, ligaments, disks, blood vessels and nerves. The actual injury to soft tissues happens so rapidly that normal protective muscle reflexes cannot respond in time to decrease or prevent the injury,” according to a 2006 case report in the Journal of the American Chiropractic Association.3

The Diagnosis

To diagnose whiplash, a DC must first take a thorough history of the injury and the patient’s previous medical history. Pre-existing conditions, such as arthritis, may increase the severity of the whiplash. The DC should give the patient an in-depth physical examination with concentration on the neuromusculoskeletal system.

Similar to asking about whiplash injuries from motor vehicle accidents, DCs should ask the patient questions that reveal the details of a sports-related incident. DCs must ask patients with vehicular accident injuries, “Where was the impact from? Were you moving at the time? Did you have a seatbelt on? What type of seatbelt? Were you braced for impact? Did you hit anything in the vehicle?” says Dr. Alan Sokoloff, team chiropractor for the Baltimore Ravens. “You have to do the same for sport-related neck injuries, too,” he says.

Dr. Sokoloff explains that he “encounters doctors that say, ‘I do not treat sports injuries,’ but if you are treating injuries from auto accidents and really dig into the mechanism of the injury with all of its details, it’s pretty much the same.”

Advanced Imaging

In some cases, advanced imaging may be necessary to make a proper diagnosis. A cervical CT scan is ordered if a DC suspects cervical spine trauma, such as a vertebral fracture, if the patient complains of paresthesia of the hands, if the patient is unconscious or has severe pain together with neurological deficits, explains Jerrold Simon, DC, president of the ACA Rehab Council.

“A cervical MRI is ordered when the whiplash patient complains of neck pain with radicular symptoms, such as a tingling sensation radiating down the arms or if there is suspected cervical spine trauma and the clinical findings suggest ligamentous damage. A cervical MRI may be ordered as a follow-up to normal cervical CT scan if the above symptoms are present,” says Dr. Simon.

Treatment

In treating whiplash injury, patients should be reminded to stay active, unless immobilization is necessary due to serious injury. “A cervical foam collar may be needed during the first few days following the incident if the cervical trauma is severe. However, in general, cervical collars are not recommended,” says Dr. Simon.

Immediately after the whiplash injury, Dr. Simon applies an ice compress to the posterior para-cervical spine musculature for about 10 minutes on a periodic basis. Ice compresses are generally only used for the first 48 hours after an injury.4

“A nutritional intervention for pain should include d-Phenylalanine 250 mg/day, dl-Phenylalanine 750 mg/day, L-tryptophan 3 g/day, and instruct the patient to to avoid coffee and other caffeinated beverages,” he says.

A neck adjustment works to improve the mobility of the spine to increase range of motion, while also enhancing movement of the adjoining muscles. This will eventually eliminate pain, soreness and stiffness and allow a patient to painlessly turn and tilt the head. In addition to adjustments, a treatment plan of mobilization, massage or rehabilitative exercises may speed up the recovery process.

“Cervical rehabilitation procedures should be considered after the initial pain and inflammation have substantially subsided,” says Dr. Simon. “Then a functional capacity evaluation with focal attention to the cervical spine should be performed to assess the magnitude and degree of upper spinal functional deficiency.”

Following this test, a DC can decide if the patient should receive a treatment of isometric cervical flexion, extension and lateral flexion against resistance exercises, a proprioceptive rocker board, wobble board and/or gym ball exercises and vibration therapy.

“Every person is different, and everyone’s ability to heal is different, so how we treat patients is very individualized,” says Dr. Sokoloff. “We will use modalities initially, if indicated. We will use soft-tissue techniques, if indicated. We will usually use a chiropractic adjustment, if indicated. But the one procedure we always use is progressive rehabilitative exercises, in office and home recommendations.”

Home recommendations include proper computer and phone ergonomics, range-of-motion exercises and icing, to name a few.

“Treatment plans that do not hold the patient responsible for helping themselves cheat everyone,” says Dr. Sokoloff. “The more a patient is informed about home icing instructions, home exercise and activity of daily living modifications, the better the outcomes are for everyone.”

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